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A “barium swallow” is a radiographic (x-ray) examination of the upper gastrointestinal (GI) tract. It is used specifically to analyze the pharynx
(back of mouth and throat) and the esophagus (hollow tube of muscle extending from below the tongue to the stomach).
The pharynx and esophagus are made visible on x-ray film by a liquid suspension called barium that is swallowed by the patient before the test.
A barium swallow may be performed separately or as part of an upper gastrointestinal (UGI) series, which evaluates the esophagus, stomach,
and duodenum (first part of the small intestine).
Using X-Rays
X-rays use invisible electromagnetic energy beams to produce images of internal tissues, bones, and organs on film. X-rays pass through body
tissues onto specially-treated plates (similar to camera film) and a “negative” of the picture is made. The more solid a structure is, the whiter it
appears on the film.
Using Fluoroscopy
Fluoroscopy may also be used during a barium swallow. Fluoroscopy is a study of moving body structures -- a kind of “x-ray movie.” A
continuous x-ray beam is passed through the body part being examined. The images are then transmitted to a TV-like monitor so that the body
part and its motion can be seen in detail.
In barium x-rays, fluoroscopy allows the radiologist to see the movement of the barium through the pharynx and esophagus as a person drinks it.
This is the basis of the name “barium swallow.”
The Barium Suspension
Barium is a dry, chalky, metallic powder that is mixed with water to make a thick, milkshake-like drink. Barium absorbs x-rays and appears white
on x-ray film. When swallowed, the barium coats the inside walls of the pharynx and esophagus so these organs and their movement are visible
on x-ray.
A Barium Swallow Exposes Abnormalities
Some abnormalities of the pharynx and/or esophagus that may be detected by a barium swallow include tumors, ulcers, hernias, diverticula
(pouches), strictures (narrowing), inflammation, and swallowing difficulties.
Risks of a Barium Swallow
The amount of radiation used during a barium swallow is considered minimal; therefore, the risk for radiation exposure is very low. If you are
pregnant or suspect that you may be pregnant, however, you should notify your physician. Radiation exposure during pregnancy may lead to
birth defects.
Patients who are allergic to or sensitive to medications, contrast dyes, iodine, shellfish, or latex should notify their physician. Constipation or fecal
impaction may occur if the barium is not completely eliminated from the body.
Is a Barium Swallow Safe for Everyone?
Some people should not have a barium swallow examination. These include people who:
Have a bowel perforation.
Have severe constipation.
Are pregnant.
Experience severe swallowing difficulty, which may increase the risk of aspiration (entry of barium into the lungs).
There may be other risks depending upon a person’s specific medical condition. Discuss any concerns with your physician before the procedure.
Factors Influencing Accuracy of a Barium Swallow Exam
Certain factors or conditions may influence the accuracy of a barium swallow exam. For example, a recent barium enema or cholangiography
procedure may interfere with the x-ray exposure of the upper GI area.
Preparing for the Barium Swallow
You must fast for eight hours before the procedure, generally after midnight.
Notify your physician if any of the following apply to you:
You are pregnant or suspect that you may be pregnant.
You are sensitive to (or allergic to) any medications, latex, tape, or anesthetic agents (local and general).
You have had a recent barium x-ray or cholangiography procedure.
You are taking any prescription or over-the-counter medications or herbal supplements (your physician may ask you to withhold certain
medications before the procedure.)
Based upon your medical condition, your physician may request other specific preparation.
The Barium Swallow Procedure
A barium swallow may be performed on an outpatient basis or as part of your stay in a hospital. Procedures vary depending on your condition
and the physician’s practices. A barium swallow generally follows this process:
You will remove any clothing, jewelry, or other objects that may interfere with the procedure.
If you are asked to remove your clothing, you will be given a gown to wear.
You will be positioned on an x-ray table and be asked to change positions (e.g., lying on your side, back, or stomach) or hold your breath at
times during the procedure.
Standard x-rays of the heart, lung, and abdomen may be performed first.
The radiologist will ask you to take a swallow of a barium drink. The barium is usually flavored, although it may not be pleasant to taste.
As you swallow the barium, the radiologist will take single pictures, a series of x-rays, or a video (fluoroscopy) to observe the barium moving
through the pharynx.
You will be asked to swallow a thinner barium drink. X-rays and/or fluoroscopy will be used to view the barium as it passes through the
esophagus. You may also be asked to swallow a barium “marshmallow” -- a small piece of barium-soaked bread -- which can help to visualize
certain structural problems of the esophagus.
If an additional procedure called a “small bowel follow through” has been requested, it will be performed after the barium swallow has been
completed.
After the Procedure
After the barium swallow examination, you can resume your normal diet and activities unless your physician advises you differently. Barium may
cause constipation or possible impaction after the procedure if it is not completely eliminated from your body. You may be advised to drink plenty
of fluids and eat foods high in fiber to expel the barium from the body. You may also be given a cathartic or laxative to help expel the barium.
Since barium is not absorbed into the body but passes through the entire intestinal tract, your bowel movements may be lighter in color until all of
the barium has been excreted.
Notify your physician if you experience any of the following:
Difficulty with (or an inability to have) bowel movements.
Pain and/or distention of the abdomen.
Stools that are smaller in diameter than normal.
Your physician may give you additional or alternate instructions after the procedure, depending on your particular situation.